The overall service plan was prepared in the context of difficult financial circumstances. The Minister for Health referred to a number of key policy proposals on the role of the special delivery unit in reducing waiting lists and achieving throughput in the acute hospital system. However, the plan states in respect of older people: "It is expected that if the anticipated reduction in staff numbers materialises, a minimum of 555 public beds will close in the course of the year". The plan goes on to indicate that up to 900 beds could close in the public nursing home system. Certain patients in acute hospitals should be moved to step down or recuperative facilities but if we close these beds we face difficulties in trying to find alternative accommodation for them. It is as sure as night follows day that there will be problems in placing people in step down accommodation if community nursing home beds are closed.
Health Service Plan 2012: Statements (Resumed)
The Deputy is wrong.
We will judge that but my observation is shared by others. I cannot always be wrong.
Have I ever suggested that the Deputy is always wrong?
There are concerns that closing these beds will create difficulties. I remind the Minister that he passionately held that view only this time last year, when he stated that bed closures would result in delays and cancellations in elective surgery. He was an advocate of more beds in the hospital system. He is not credible when he now claims the exact opposite is the case.
In regard to the idea that we can foist the beds onto community groups, many of these nursing homes need capital injections to meet the standards HIQA will be forcing on them and that will be difficult in straitened times. The plan states: "This is likely to require a combination of actions such as consolidation of services; changes in staffing, skill mix and work practices; consideration of the public and private capacity available within an area and ... other voluntary providers". The proposal to farm these community and public nursing homes out in the vain hope that voluntary organisations will keep them afloat is far-fetched to say the least. If we are serious about using the special delivery unit to achieve throughput, step down convalescence facilities involving quality beds will be required. That is what the Minister originally proposed but, unfortunately, taking as many as 1,000 beds out of the system will lead to a back log in the acute hospital system.
We need to debate the question of universal health insurance prior to the implementation of the Minister's proposals because we are not sure what guidelines were laid down. Has a cost analysis been conducted? Will the public be expected to pay an inordinate amount in mandatory health insurance? How will the means testing system be developed and how will entitlements to subvention to be decided? We accept the need to provide some form of guaranteed funding to ensure people get treatment when they need it as opposed to if they can afford it. Equally, however, it is a myth that universal health insurance will be free. It will cost a lot of money. People will have to pay considerable amounts for a mandatory health insurance system, either through general taxation or health insurance. Either way, it will not be free.
This time last year the Minister was almost falling over himself in apoplectic rage about the hike in the community rating levy of 11% or 12% yet he recently announced a 40% increase. I cannot take him seriously given that this time last year he said this would drive families away from private health insurance and cripple them in terms of being able to afford health insurance. However, two actions of his in the past six weeks have put enormous pressure on insurance companies and as sure as night follows day, even with the best will in the world on his part and his diktat, it will lead to increased premiums on hard-pressed families. The idea that all insurance companies will be charged the full amount even if the patient is treated in a public bed will inevitably lead to increased premiums.
His second decision was to apply a 40% increase on the community rating levy. If a smaller percentage last year caused him such distress, surely a 40% increase will cause him more distress this year. He blindly passed it off claiming it would not increase insurance premiums. However, it has already increased insurance premiums and it will continue to increase them. I am making the point that this is a serious issue.
Everybody wants a system that allows people to access medical services based on need as opposed to ability to pay. It is wrong to believe that those who have private health insurance are somehow an elite group with endless resources. Many people are making great sacrifices to continue to pay their private health insurance premiums and are making very difficult choices about putting heating oil in the tank or paying for private health insurance. Any increase puts enormous pressure on them. The number of people falling out of private health insurance is astonishing. Some 60,000 did so last year and it could be up to 100,000 this year. While the Minister is talking about universal health insurance on the one hand, a group of people who are trying to provide as best they can for themselves and their families are being hard-pressed and forced out of health insurance. The Minister's policies are not helping and are increasing the premiums health insurers will charge for cover.
The difficulty is that it creates concern and anxiety among people who are asking whether they can afford to pay €3,000 this year and whether it is a waste of time paying for it. If it is a waste of time paying for it and if the Minister has a grand plan for universal health insurance, he should publish it as quickly as he can and give people some comfort in knowing what will be ahead of them in the years to come. Waiting until 2016 or 2017 and claiming it is a ten-year project creates enormous uncertainty in the meantime.
Fianna Fáil failed to introduce risk equalisation for years.
I certainly do not commend the health service plan to the House.
The HSE national service plan 2012 implements the continuing regime of cruel cuts begun by the Fianna Fáil and Green Party Government, and now continued by the Fine Gael and Labour coalition. This is a plan for the wholesale destruction of services across all sectors of our health care system. It is no wonder that the Government will do anything to avoid a referendum on the EU austerity treaty because this plan and the widespread cuts to vital services represent austerity in action.
When Minister for Transport, Tourism and Sport, Deputy Varadkar, insulted the intelligence of the people by asserting that a referendum would be undemocratic, he said it would focus on issues not related to the referendum question. Of course he and his colleagues know very well that a referendum debate will rightly focus on the cuts imposed by the Government because, if the austerity treaty is adopted, the State will be locking itself into an economic straitjacket that will mean years of further cuts to our services in health, education and social protection.
This service plan spells misery in 2012 and beyond for people who use our health services and the staff who deliver those services. These are the public health services on which we all depend, the public services that must still be provided while the private sector can pick and choose which services it will provide based on the profit motive. The health budget reduction of €750 million as a result of budget 2012 comes after the €1 billion reduction in 2011. The Minister for Health, Deputy Reilly, has claimed that front line services can be preserved through greater efficiency. This is directly contradicted by the plan which states "the bulk of the reductions that the HSE is required to deliver in 2012 will impact increasingly directly on frontline services".
We now know that 3,500 staff are leaving the HSE at the end of this month and we also know that there is no plan to ensure that the services affected by this exodus will not be drastically curtailed. The Minister for Public Expenditure and Reform has tried to portray the redundancies as almost a technical industrial relations matter. In truth this is all part of the drive to drastically reduce public services and the public pay bill in pursuit of the Government's doomed austerity programme. The key point is that the recruitment embargo remains in place, with some exceptions, and that this further and dramatic exodus from the public health services will deal a body blow to the provision of services to patients. The service plan states that it will have to be reviewed later this year depending on the numbers of staff leaving the service. In other words we may be prepared for more cuts later in 2012.
Again the plan contradicts the Minister's repeated assurances that front line care can be protected. The plan states that "efficiencies will not compensate for the loss of frontline healthcare delivery staff in such large numbers". The scale of these departures of staff from the HSE will mean a major blow to health services in this State. Front line services cannot be maintained with such a scale of redundancies. The loss of nurses in particular will mean a serious reduction in services for patients.
Meanwhile, as the 3,500 staff depart, the Minister has signalled his intent to tinker with the bureaucracy at the top of the HSE, but without reducing the 110 senior managers on annual salaries of more than €110,000. He should reduce these salaries and ring-fence all front line health service posts, lifting the recruitment embargo so that vital patient care can be provided. In his contribution earlier, the Minister stated that he intends creating consolidated management structures. I have no issue with less management given that we need more front line service providers. However, he did not say earlier when he would announce the hospital groupings.
Under this plan we face the loss of nearly 600 beds in public nursing homes which will be a devastating blow. I am certain that communities will increasingly resist these cuts of beds and the threatened closure of homes across this State. Last Saturday, along with Deputies representing all political views in this House, I addressed a rally in Ardee, County Louth, where St. Joseph's public nursing home is threatened with closure under this plan. The Minister has put public nursing homes of 50 or fewer beds on notice. They are told they are uneconomic and that they face closure. At a recent meeting of the Oireachtas Joint Committee on Health and Children, HIQA representatives confirmed, when questioned by my colleague Deputy Colreavy, that there are no inherent safety or quality issues with homes of fewer than 50 beds. This is purely a budgetary measure.
However, I believe it goes further. There is clearly a move to close public nursing homes altogether. The HSE can barely disguise its desire to abandon care of older people completely to the private sector. The current accelerated trend began with Loughloe House in Athlone in 2010. It has continued with other homes, including St. Brigid's in Crooksling, County Dublin, which has considerably more than 50 beds. The Minister has ordered a brief moratorium in that case, but the intention of the HSE to close it is very clear. It is a dangerous precedent that, if allowed to proceed, would spell the end of public nursing home provision in this State. The cuts imposed in this service plan can only accelerate that process. I remind the House of the statistics. From 2001 to 2010 long-stay public nursing home beds for the elderly dropped from more than 10,000 to just above 6,000.
During the same period the private nursing home capacity rose from well below 10,000 to over 20,000, supported by tax incentives.
Repeatedly, we hear the assertion from the Minister and others that the emphasis in care of older people is switching from residential care to care in the home. Yet, almost unbelievably, this service plan imposes cuts to home help hours. We are told this is only by 1.2% but this is coming from a low base with existing provision of home help totally inadequate to meet the need that exists. Given public nursing home bed closures, the pressure will increase to provide support for older people in their homes but this plan offers less, not more.
The attacks on services to older people range from complete closure of facilities to the meanest of cutbacks in existing services. For example, in the Minister's constituency the HSE is proposing to stop the preparation of cooked meals at Lusk Community Nursing Home and instead to transport meals from St. Ita's Hospital, Portrane, which will be reheated or refrigerated in Lusk. I believe this contravenes HIQA standards and I call on the Minister to put a stop to it and not to allow yet another such precedent to be set.
The same story of cutbacks is true for people with disabilities. The plan will impose reductions in day services, residential services and respite services. We all know that these services are inadequate as they stand and that there is a growing burden on people with disabilities and on carers. Much is made of the additional €35 million allocated to mental health, but last week at the Committee of Public Accounts the HSE chief confirmed to committee members that while he intends to take on 400 mental health staff, at least 500 mental health staff will leave the health service at the end of the month as part of the mass redundancy. In mental health, as in other sectors of our health services, the Government has no plan to address the loss of numbers, the loss of experience, the loss of skill and the inevitable gaps that will appear in the front line in this unplanned and arbitrary redundancy programme. I shudder to think of the consequences of this plan and of the mass exodus of staff from our acute hospitals. Every Deputy can cite examples in his or her constituency. Recently, management of Cavan General Hospital sanctioned cutbacks of 25% to its outpatient department staffing and it has begun radically reducing elective surgery at the hospital as and from last week.
Members of the Irish Nurses and Midwives Organisation said they were appalled that management drew up such plans in the absence of any consultation or discussion at local level. They said the plans will lead to excessive waiting times and the extension of waiting lists for patients in what is already an over-stretched service. The limiting and reduction of elective surgery at Cavan General Hospital will mean longer waiting lists and further unnecessary suffering for patients awaiting surgery. Late last year, we called for an inquiry into the disgraceful overcrowding in the accident and emergency department at Our Lady of Lourdes Hospital in Drogheda. Cavan and Drogheda continue to suffer and face a worse situation in 2012 thanks to this service plan.
Last October, I asked the Minister during an exchange between us if he agreed that more beds closed meant more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations. Deputy Kelleher referred to this earlier. The Minister replied: "I do not agree that more beds closed means more patients on trolleys and more people waiting". Then, I pointed out that in May 2010 some 33 beds were closed in Beaumont Hospital but the Minister stated in the House: "More beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations". Those were the Minister's words. The record shows it and it stands. I make no apology for reminding the Minister and the Dáil of that contradiction and I will continue to do so.
Do the members of the Labour Party remember what their then health spokesperson, Deputy Jan O'Sullivan, said almost one year ago on 8 February 2011? She said in an interview in The Irish Times: “In the first months of government, we will lift the moratorium on replacement of frontline staff where beds or operating theatres are closed because of a shortage of nurses”. There are people of conscience within the Labour Party and on the Labour Party benches in the House and I appeal to them to examine this service plan, to examine the austerity treaty and to ask themselves if this is what they wish to inflict on the people for the next decade and beyond.
When it was put to the Taoiseach last week that leading obstetricians held that the exodus of staff and the cuts would put lives in danger, the Taoiseach responded by portraying that statement as an attack on the staff who are leaving. Naturally, it was no such thing. Dr. Sam Coulter-Smith, Master of the Rotunda Hospital, one of the State's largest maternity hospitals, has stated that the hospital's midwife to patient ratios are already severely compromised. He told the Irish Examiner: “You reach a point when you can’t stretch the service any further, and we are at that point now”. He said he absolutely agreed with concerns raised by consultant obstetrician Dr. Gerry Burke, based in Limerick, that some women and babies may pay “with their lives” as midwives leave the service in droves. Dr. Burke had stated that St. Munchin’s Regional Maternity Hospital in Limerick, which caters for more than 6,000 women and 5,200 newborns annually, will have lost 47 midwives from a staff of just over 200 through retirement.
That is inaccurate.
Those are the figures and we will see by 29 February. He said the HSE had not demonstrated how it intended to deal with the shortfall. The Minister should deal with the shortfall and tell us what the contingency plan is.
The contingency plan is there.
What is the Minister's contingency plan in that area and throughout the health services? It is not contained in the Minister's health service plan 2012.
We could use a little accuracy.
The Minister may have no regard for it but the Labour Party Deputies should have regard for Dr. Burke's view because he is the chair of their party in Limerick City.
Does Deputy Ó Caoláin of Sinn Féin want to tie up my political conscience?
The Irish Nurses and Midwives Organisation, INMO, general secretary Liam Doran has said the country's maternity services will be facing a very severe crisis come the end of February, but the remarks of the head of the HSE's maternity services programme have received less attention. Let us go to the heart of the matter and see where the Minister stands. Professor Michael Turner, director of the HSE's obstetrics and gynaecology programme, told irishhealth.com he is concerned that Ireland’s historically low maternal and infant mortality rates could increase in future if funding and resourcing of maternity care is cut back too much.
I did not interrupt the Minister.
Deputy, you have one minute left.
Professor Turner said:
We still have one of the lowest maternal mortality ratios in the world. Having said that, there can be no room for complacency. My concern is that unless we prioritise maternity services we will see in the future an increase in maternal deaths if we cut maternity resources too much - that is the price that will be paid.
And then what usually happens is there is a crisis and a knee-jerk response. We could face the same danger with our perinatal mortality rates.
He said the health service recruitment embargo had hit maternity care as it had other areas of the service. I fail to see how the Minister finds all of this humorous.
I do not find it funny.
I will quote Professor Turner once more to remind the Minister of what he said: "This is an important issue that we are discussing with the HSE".
Your time is up, Deputy. You must conclude.
I will conclude with this quotation:
This is an important issue that we are discussing with the HSE. It should be pointed out that Ireland has the lowest number of consultant obstetricians among OECD countries. Greece, which has also had the IMF in, has nine times as many obstetricians as we have.
The Minister, Deputy Reilly, is presiding over a disgrace. I have it to say that what the Minister is doing now is shameful and I call on him to stop these cuts, to lift the recruitment embargo on front line services and to commence the process of restoring to use a significant number of now closed public hospital beds.
I would have preferred more time to discuss the document. Unfortunately, I have only five or six minutes so I will concentrate on my area of Waterford.
Deputy, are you sharing time?
I am sharing with Deputies Finian McGrath and Seamus Healy.
Many of us are having great difficulty coming to terms with how the HSE expects hospitals to meet the ambitious targets for emergency departments and elective surgery set out in the national service plan while battling with an average budget drop of approximately 4.4%. This is not possible.
In my constituency of Waterford, for example, waiting lists for specialist treatment and surgery are about to get longer. No amount of spin can gloss over the cold, hard reality of budget reductions coupled with the Government moratorium on staff recruitment and the expected increase in the numbers of staff retiring early due to the change in pension entitlements. To put it candidly, with significant number of people leaving the service and the increasing numbers of people using the service, how can we possibly say we will have a service that is worthwhile? That is not possible. All one needs to do to realise this is to speak to nurses, doctors and front line service providers. I am not saying the Minister does not do this - obviously he does. We in opposition speak to these people every day of the week and they tell us what is happening with the service. They tell us about the waiting lists, about how people are treated, about the extra hard work they have to do and about the stress they are under. There is no question but that this is happening in hospitals all over Ireland.
Waterford Regional Hospital serves 500,000 people across the south east, but it faces cuts up to €14 million, the departure of up to 70 nurses by next month and the closure of three of its eight operating theatres, a surgical ward and a number of inpatient and outpatient beds. The shortage of nurses has already a caused a reduction in beds and the closure of an entire ward, with 25 beds taken out of commission. On a personal level, last week a 92 year old friend of mine was left waiting in a chair for hours before he could get a bed. There was not even a trolley for him. How can this happen? I do not question the Minister's integrity. I listened to him when he was in opposition and liked what he said then. I understand it is a difficult situation due to the budgetary cuts, but when a 92 year old man is left stressed and sitting in a wheelchair in 2012, we must ask what is happening in this country. How come we allow this to happen?
It is for this reason that I and other Deputies cannot support what the Minister has put before us. We know that over the next number of months and years significant numbers of people will suffer. We have no option but to talk to the Minister and the Government. I do not like to use the word "blame". I have said on a number of occasions that despite the difficulty I have with the Government, it must be given time to make changes. I liked what I heard from the Minister when he was an Opposition Deputy, but now he is not listening to people on the ground. He could not possibly be listening to nurses, doctors and those in accident and emergency wards. If he was listening, he would know that things have become extraordinarily more difficult over the past number of months. They will continue to become more difficult following the cuts in service.
Putting the matter simply, if more people need and come in to use the health services while we cut down on numbers and do not replace them - we have a moratorium on recruitment - how can there be any improvement in the service? It is not possible to improve the service in that situation.
We have improved the trolley count and the waiting lists.
I am sorry, but I must suggest to the Minister that he should come to Waterford. He is always welcome in Waterford. He should pop down to the Waterford Regional Hospital, which serves 500,000 people, and speak to the staff, nurses and doctors there. He should visit at 5 a.m. on a Thursday or Friday morning and see what is happening in the accident and emergency ward and then tell me that the service is improving. It is not. I urge the Minister to revisit this and to lift the moratorium on staff recruitment. This plan is a disaster and will not work. It is a disaster in every hospital across Ireland. Many other Deputies will say the same. At the very least, the Minister should lift the moratorium. If the does not, he will regret it in a number of years time.
Look at the IMO trolley count. The numbers speak for themselves.
I strongly endorse what my colleague, Deputy Halligan, said and thank the Chair for the opportunity to speak on the issue of the health service plan. This is an extremely difficult time for our country and difficult decisions must be made, but leadership is also needed. By leadership, I mean we need a Minister who is not afraid to hit the wealthy and elite in society and deliver health services to people on the ground. We do not need more reports, plans, waffle or spin. What we need is action and sensible investment in our health services. We also need reform. I emphasise the word "sensible", because the Government seems to have lost the run of itself with the measures it is taking to deal with the economy. This has significant import for this debate.
The issues of spending, tax and health are all linked and we should never forget that. Last weekend, for example, the Nobel Laureate, Professor Joseph Stiglitz, asked an important question about the current international economic debt and banking crisis, namely, why taxpayers should have to give up health and education to make good on a private bank. I totally agree with him and see this question as linked to the national service plan before us.
Let us look at the details of the national service plan 2012. It sets out the type and volume of health service and proposes a spend of €13.317 billion and caps then on employment. Cost reductions proposed for 2012 are in the region of €750 million. I accept that we must have reform and that this reform must begin now, but these proposals will have a substantial negative effect on our health service. This is the basic plan, but the position on the ground is much worse. Only today, I was told that an elderly disabled constituent of mine is to have his home help hours cut. His family is in crisis as I speak. This is not good enough. Senior citizens or patients should never have to pay for the actions of the greedy and of those who wrecked this country.
Let us look at proposed capital projects. Value for money is the name of the game in the current climate. For example, the cystic fibrosis unit for St. Vincent's Hospital was to cost approximately €30 million. That cost is now down to between €20 million and €22 million. Will that unit be on target and will the 34 cystic fibrosis beds be available this summer? While this is an important capital project, it is even more important for patients and must be pushed to the limit to achieve it. With regard to hospitals and reform, I agree we must have reforms and change in our health service. We must go back to the basic vision of a universal health care service.
Beaumont Hospital is in my constituency and yesterday I received a number of calls from families of patients who must visit the hospital regularly because members of their families are seriously ill. These people must park at the hospital for many hours and the charges come to a significant amount daily. I urge the Minister to do something for such families. Not only must they suffer because a member of their family is seriously ill, they must pay a significant amount in parking charges.
With regard to finance, the budget provision for 2012 represents a major challenge for us all and comes at a time when the Minister for Health is seeking cuts of €750 million. As I said earlier, this will cause a major crisis in our health service. In the case of services for older persons, the proposed cost reduction required averages 2.3%, but I notice a reduction of 4.5% will be applied to home help hours. However, the Minister says that service efficiencies in this area will mean that despite this reduction, the number of people in receipt of home help will only be reduced by 1.2%. Earlier, I mentioned the negative impact this will have on families.
The allocation in the programme for people with disabilities will reduce by 3.7%. Why are people ringing my office about this and why are people at the frontline telling me that people with disabilities are being asked to take cuts of from 7% to 10%? These cuts will have a negative impact on services for people with disabilities and will mean a reduction in day care places and respite places. Above all, it will impact the emergency situations that arise when elderly parents of people with intellectual disabilities die or when there is some other crisis in the family. I urge the Minister to look seriously at this issue and bring in a serious health service plan.
In the five minutes available to me, I would like to deal with the section in the report dealing with mental health services on pages 48 to 53, and specifically, the item on page 49 in respect of the closure of acute inpatient psychiatric facilities in HSE South. This proposes the closure of 61 beds, 29 of which are in St. Michael's acute psychiatric inpatient unit at South Tipperary General Hospital, as the Minister knows well. This matter has been raised for quite some time, and I hope that he can clarify the situation for us.
The proposal to close these beds is a fundamental breach of the document, A Vision for Change. That document, published in 2006, is something everybody in this Chamber completely supports, as do the stakeholders in south Tipperary. That document is a policy for integrated services and holistic services for service users in any particular area. It predominantly operates on a community basis, which we all completely support. It also has a number of other elements such as inpatient acute services and specialist services.
In breach of that policy, the HSE and the Department are going full steam ahead with the closure of the acute beds at St. Michael's unit in South Tipperary General Hospital. There was no prior consultation on this. It was announced overnight and all the stakeholders - service users, health professionals, be they medical or nursing, general practitioners, the general public and professionals in the unit in St. Luke's Hospital in Kilkenny where these beds are to be moved - are all opposed to this development and they have informed the Minister of their opposition. It fundamentally breaches the terms of the document, A Vision for Change and the policy from that document. That policy is crucial in its reference to access for service users to inpatient services and access for carers and family members to those services. It allows for the provision of a 25 bed unit in both Kilkenny and south Tipperary. We are asking that the policy be implemented in south Tipperary.
The HSE and the Minister of State have said on numerous occasions that this closure would not go ahead until the community based services were in place. I can confirm that the executive director, the hospital manager and the director of nursing have informed staff that the unit will close to admissions on 1 March and will close completely on 31 March. The other services are not in place. There is no crisis house. The high support hostel is not ready. The home-based teams do not have allied health professionals. There is no social worker, no psychologist and no occupational therapist. There are no on-call arrangements in place and there are no arrangements for service users to attend accident and emergency departments.
I am making a personal appeal to the Minister this evening. He has met us in south Tipperary on a number of occasions, and I thank him sincerely for that. He knows that we are reasonable people and I ask that he clarifies this issue and instructs the HSE not to go ahead with the closure on 1 March-----
The Deputy is over time.
I will finish by asking the Minister to become involved in this and to meet a deputation of stakeholders from south Tipperary on this issue. It is a fundamental breach of the policy but is also a breach of the promises that have been given about other services being in place before any beds close at St. Michael's unit. Those services are not in place and I ask the Minister to clarify the position, to stop the closure and to allow for admissions to continue after 1 March, and to meet a deputation of stakeholders from south Tipperary. He knows that we are reasonable people and he should give us an opportunity to clarify these issues with him.
I welcome the opportunity to speak this afternoon on the HSE national service plan. As was the case in 2011, this year will once again provide severe challenges to the Minister, his Department and all of the medical and administrative staff working in the health services in our country. By the end of 2012, a total of €2.5 billion will have been taken out of the health budget over the past three years. There will also be a significant reduction in staff numbers over the next few months. It is important to compliment the Government, and this Minister in particular, on the fact that the commitment to a single tier health service based on need rather income remains in place, and more importantly, on target.
This morning in the Dáil, a former Minister for Health and now leader of Fianna Fáil and the Opposition said "I do not care about monitoring".
Deputy Murphy does not care about St. Mary's.
Deputy Kelleher never spoke about St. Mary's, before or since.
We definitely know what Deputy Murphy said.
I did not lead them up the garden path anyway.
This was more or less the case from the time the HSE was established by Deputy Martin and in all subsequent Governments of which he was a member. Ironically, monitoring - dismissed by Fianna Fáil-led Governments - remains at the heart of the difference between this Minister and his immediate predecessors Cowen, Martin and Harney. He is targeting objectives and monitoring how these targets are performing. This plan commits the HSE to minimising the impact on services from budget and staff reductions by using reduced resources more efficiently. It crucially commits to moving to new models of care across all areas of service which treat patients. This will be done at the lowest level of complexity and will provide quality services at the least possible cost. This is not only financially preferable, but also far better for the patient.
I particularly welcome the significant strengthening of primary care services, some of which will indeed be located on the site of St. Mary's medical campus on the north side of Cork city.
Is that another promise?
These include the issuing of GP visiting cards to people with long-term illnesses. This is another step on the planned and monitored march towards free GP care for all, and ultimately the Government's stated objective of universal health insurance.
While the Opposition will understandably focus on some perceived and indeed real reductions in services caused by the Government's obligation and requirement to move Ireland back to solvency and independence, it is also important to acknowledge areas of reform and improvement. These include proposals to protect the viability of community and nursing units and to increase the capacity of immediate care for elderly people. An additional €35 million will be allocated to child and adolescent services, which also confirms the Government's commitment to young people in our country. They are our most valuable resource and for the first time they have a voice at Cabinet through our excellent Minister, Deputy Fitzgerald. Other targeted areas are included, such as a tailored approach to disability, the commencement of colorectal screening, priority funding for the HPV and MMR vaccines and the progression of clinical care programmes such as the national disease management programme for diabetes.
It is important to correct some of the allegations made today by the Sinn Féin spokesperson, because the Minister has always made it clear that long-term care in the public sector will continue to be protected. It is reasonable to ask why this form of care costs 50% more in the public sector than in the private sector. I am pleased the Minister is addressing this issue.
The House is today discussing the reform agenda. Last week, I had the pleasure of attending a national forum of key stakeholders in the health service at which the Minister identified four key reform priorities for 2012. These are to deliver on the special delivery unit's agenda, further overhaul the health system's governance, change the model of care and reform the health insurance sector. Targets and monitoring were the main purpose of last week's gathering of the people running the health system. The special delivery unit has already had a significant impact on hospital performance and is improving patient experiences in a tangible manner. Improvements in these areas are taking place for the first time in many years.
Several Deputies referred to people waiting on trolleys. The Government's view is that it is unacceptable for anyone to wait on a trolley. It is important, however, to refer to a bold statement made by the Minister last year when he set priorities for 2011 because it caused amusement and raised eyebrows at the time. The cumulative number of patients waiting on trolleys in the first two to three weeks of this year was 27% lower than in the same period last year. While the number of people waiting on trolleys remains too high, last month was the first time such a significant reduction was recorded.
On waiting lists for scheduled care, last year the Minister directed that all public hospitals were to ensure they did not have any patients waiting for more than 12 months by the end of 2011. With the exception of one or two hospitals in Galway, this target was achieved.
Last week, the Minister announced his targets and objectives for 2012. The maximum period anyone should wait for elective care has been reduced from 12 to nine months. Cumulative improvements and targets are being introduced which can and must be achieved. This will be all the more difficult given the economic climate and reductions in budgets. One of the new targets is that no one should wait on a trolley for an emergency bed for longer than nine hours.
Is it acceptable to have people waiting for nine hours?
No one should wait for two hours for a bed.
Furthermore, under the new targets, 95% of people should not wait for more than six hours for an emergency bed. While the Government agrees that no one should be on a trolley, if anyone believes the disastrous position that pertained in the health system over the past 14 years can be cleaned up and changed in one month, one year or even two years, he or she is seriously delusional. Steady and large reductions in waiting times are being achieved. The special delivery unit will also set and implement targets for improved access to outpatient and diagnostic services in the first quarter of 2012.
I wish the Minister and his staff well. For the first time in years, it must be acknowledged that some key areas of the health service are improving, even if not all battles or wars have been won. While there is still scope to target other areas, there is light at the end of the tunnel and evidence to show that the targeting, monitoring and direct control of the HSE by a competent and experienced Minister who understands his portfolio is delivering benefits.
I emphasise that the facts and figures I have cited on waiting lists and the people on trolleys were compiled not by officials in the Department or Health Service Executive but the nursing unions. They alone are tabulating and delivering the figures for everyone to see.
I welcome the opportunity to contribute to the debate on the Health Service Executive's plan for the health service for 2012. As public representatives, Members interact daily with the HSE and health service on behalf of constituents. We also do so in our family roles.
I will address a number of issues. Home helps provide value for money in providing services for people who need help in their own homes, primarily elderly people. Since being introduced on a structured basis, the home help service has delivered major benefits for patients, their families, the wider community and, by extension, the State. Home helps have achieved great success in keeping people in need of assistance in their own homes and local communities. For this reason, any reduction in the home help service should be carefully targeted.
Delays in processing medical card applications have been raised in a number of forums in recent weeks. In many cases, those who are forced to wait for medical cards have been diagnosed with serious illnesses. Having been informed by their general practitioner or consultant that they have an entitlement to a medical card, they are encountering serious difficulties in securing their entitlement. The system used to provide medical cards needs to be challenged and taken by the scruff of the neck, so to speak. Those applying for medical cards tend to be on the lowest incomes and are, therefore, highly vulnerable. Public representatives, whether Members of the Dáil or Seanad or local authority councillors, are being contacted by a large number of people. We have seen at first hand people who have been diagnosed with serious illnesses and must have a medical card if they are to pay for their medication. Not only must they deal with their illness and the financial burden of their diagnosis but they must wait for long periods to receive a medical card. The Minister should give a commitment to address blockages in the system. He should issue a directive requiring that problems in the current shambolic system be ironed out.
In recent weeks, I had reason to speak with a hospital consultant who informed me that in his 25 years working in the health service he has never seen circumstances as bad as they were in recent weeks. He noted that whereas budgetary issues are usually not a major theme in January, he has been forced to cancel more day and theatre procedures than at any other time in his career. He asked me to raise this issue in the House. It is not possible to have all diagnostic procedures and other treatments carried out in the primary care sector. There is a fundamental need for hospital services to be backed up in every way possible and to ensure accident and emergency services and admissions are properly resourced. He was genuinely concerned about his patients and what he saw around him and was not making a political point, good, bad or indifferent. The situation is difficult and challenging at the moment.
Over the years Mallow General Hospital has provided a huge service to the people of north Cork and beyond. In any assessment of Mallow General Hospital, it always has been said that it is one of the most efficient hospitals. It is the first point of call for many people. In downgrading services or amalgamating services into centres of excellence or whatever, it is vitally important we acknowledge the contribution hospitals, such as Mallow General Hospital, have made to the State over the years.
It is vital that Mallow General Hospital is protected because in Cork, everything is being centralised into Cork University Hospital and other places. When elderly relatives of mine go to Cork University Hospital, it is chaotic not only inside the hospital but outside it. Any attempt by the HSE, the Department of Health, the Minister for Health or the Government to downgrade any of the services in these communities would be a retrograde step. It would have disastrous consequences not only for the HSE delivering the plan but in regard to the fundamental issue of money.
In recent weeks, there has been huge concern about the preservation of community hospitals. It could be a case of penny wise and pound foolish. Over the years these community hospitals provided even more services. By and large, they take in acute medical cases who need long-term care and assistance while the nursing homes take the other people. There are three community hospitals in my local area - Macroom, Millstreet and Kanturk - all of which have provided a huge service. Those three centres have been commended by HIQA on the care they provide. In the first instance, we must consider the residents of those community hospitals who are attached to their communities in a very significant way. They also have family support in their communities and can be visited by friends and neighbours.
The policy always has been to accommodate the acute medical cases. All but one of the patients served by the 38-bed Macroom Community Hospital are maximum or high dependency, meaning that most of them could not be cared for at home or even in the standard nursing home facilities. In the most recent inspection report on Macroom Community Hospital, HIQA stated:
Many factors contributed to the residents' quality of life. Relatives and friends visited the centre regularly and there was a sense of warmth and familiarity between staff, residents and relatives. The centre had a homely atmosphere where residents were encouraged to be independent and residents were encouraged to remain in contact with family and friends. Residents' health needs were overall well monitored and met.
To close Macroom Community Hospital would scatter these patients all over the community and their connections, which were rightly highlighted in the HIQA report, would be shattered. This would add to the congestion in the regional hospitals or lengthen the nursing home waiting lists. Likewise, Kanturk Community Hospital provides excellent and essential care.
Over the years, the communities have been hugely supportive of these three community hospitals. They have raised funds for the day centres or for enhancing their facilities. I suppose the communities take ownership of these hospital. The biggest difficulty with State institutions, no more than the issues in regard to the EU, is that we must bring the people with us. Communities should take ownership of their hospitals, schools and so on. It is vitally important that the contributions people have made to maintain these hospitals and the fund-raising they have done is acknowledged and maintained.
Patients in St. Joseph's Community Hospital, Millstreet, commended it. There have been huge advances in creating a better environment in that hospital. Pope John Paul II said that anyone of goodwill and good sense must agree that a society must be judged on how it treats its weakest members. It is vitally important we remember that when we reflect on the ethos in the community hospitals and the good work being done in them. We must commend them. The Department and the HSE should tread carefully and should look at the excellent work being done in these facilities and not take a blunt instrument to them.
I am pleased to contribute to the debate on the HSE national service plan for 2012. It must be said that the overall financial and service challenges facing the HSE this year are very significant. This is probably the most challenging period ever faced by our health service. We will not be able to deliver the kinds of services we want to deliver for our citizens without serious reform. This is the case across all care groups, including the child and family services.
When we focus on a report like this, there is a tendency to focus on cuts and what people are afraid will not be delivered but it is equally important to focus on what is being delivered and committed. In the case of the HSE, €13.3 billion of spending is committed to in 2012. We must ensure that spending is used in a way that is effective, efficient and delivers the services we want for our citizens. I commend my colleague, the Minister for Health, Deputy James Reilly, and his colleagues, Ministers of State, Deputies Kathleen Lynch and Róisín Shortall, on their commitment to reform and on the amount of work they are doing to ensure services are delivered and that the reform agenda is progressed in all areas.
The service plan this year is rooted in reforms aimed at ensuring the reductions in funding, which are real, will not mean an equivalent drop in the level of service, in particular through fast-tracking new, innovative and more efficient ways to deliver services supported, for example, by the work of the special delivery unit. I take the points made by Deputy Michael Moynihan on the delivery of medical cards. The Minister for Health has taken action in this regard. It is unacceptable that forms get lost and that the service is not delivered efficiently to people who badly need those medical cards. It is not good enough. We must provide a service to citizens at the core and ensure that the kinds of services we want to deliver are delivered in a speedy and efficient way.
The same applies to the points Deputy Michael Moynihan made about the elderly. While I will focus on my areas of child and family services, I would say in regard to the elderly that it is unacceptable that so many elderly have not been offered the kind of community care packages which would keep them in their communities and at home. That is something we need to consider It is an area which is being focused on more in terms of the delivery of the fair deal scheme. We need to ensure people are offered the range of community services which will ensure they are not forced into residential care but can remain in their communities.
As Minister for Children and Youth Affairs, reform is very much part of my agenda and it is central to the work of the HSE child and family services, led by the national director, Gordon Jeyes. As everybody in this House knows, there have been too many reports which have highlighted problem areas in child protection services. We have had at least 16 reports on child protection services and we have also had the very serious reports on clerical abuse. We have had the Monageer inquiry report, the Ryan report, the Roscommon child care inquiry report and, more recently, the HSE national review panel reports on serious incidents, including the death of children in care, and the HIQA inspection reports on foster care and special care services.
Analysis has not been lacking - and it is quite disturbing in many cases - about the kind of care we have provided to children. Some common themes have emerged from those reports, in particular the need for greater clarity and consistency in practice, enhanced inter-agency working, more consistent assessment, and more equitable distribution of HSE resources based on assessed need. It is no longer good enough to have the same number of people in every area, we need to match personnel to the demands of particular areas. The demands concerning child protection are very different in different counties.
We need to develop more targeted family support services, better training for our managers and staff, more staff supervision, and more reliable data collection. As Minister, I have been very disappointed by the quality of data I have been able to access concerning child protection services. I got one audit and the figures were simply not comparable across areas because people were not comparing like with like. That is not good enough. If we want to plan services we must have adequate comparable data, which must be relevant, immediate and consistent.
I expect the upcoming report of the independent review group on child deaths to provide further stark evidence of past failings over the decade 2000 to 2010. That report is currently with the Attorney General and as soon as there is legal clearance I will publish it.
This year marks the 20th anniversary of Ireland's ratification of the UN Convention on the Rights of the Child. We can mark this anniversary and make it a national cause to ensure that these problems are of the past and not of the future.
I would like to say a few words about the change agenda within child and family services. It is aimed at strengthening the organisational capacity, business processes and systems required to deliver safe and reliable child protection services. We must be able to do so. That change agenda is necessary in order to utilise resources to the full, promote better outcomes for children and achieve Government objectives for the improvement of the child protection system. In time, this will constitute an important and demonstrable example of the benefits of the Government's approach to public sector and public service reform.
The change agenda, which I am leading in the Department, will result next year in the establishment of a new and dedicated child and family support agency, as committed to in the programme for Government. This year's health service plan paves the way for that transition. We now have for the first time a dedicated subhead for child and family services within the HSE vote. In the programme for Government, we said we would separate out child protection systems from the HSE's other work, because it has not worked as part of the larger HSE service. This significant change will bring about greater transparency and budgetary control. We have a separate budget now, which is an important first step in beginning this transition.
The 2012 provision for child and family services is €568 million, which represents an increase of 4% compared to the 2011 budget. However, there will still be a requirement to control excess spending which caused severe budgetary difficulties in 2011. Accordingly, an average reduction in expenditure of 7% will be required to bring spending back from the 2011 outturn levels to the budget provision in 2012. Notwithstanding the financial constraints applying, I welcome the decision to provide an additional budget of €40 million to support child welfare and protection services this year, and to deal with the kind of budgetary problems that have arisen in the area in recent years. This reflects the priority the Government attaches to child and family services, and is an acknowledgement of the very real financial pressures experienced within this area in recent years.
I would like to give the House some idea of the areas where these pressures are being created. We have an increasing number of children coming into care of about 5%. We also have an increase in families seeking housing and support to cope with children. An increasing number of families are seeking help from our social services, including child care. There is an increase in such cases being referred to the courts, in addition to the increased costs of detention and special care. We also have increased costs arising from guardian ad litem cases. It is important that children should have somebody to represent them in court in certain cases, but this comes at a cost. We need to improve the way we manage this so a management system is required. This service was set up without any management structure.
Other key areas for the Department include the progress of a children first national guidance, which will be put on a statutory basis. I have established an interdepartmental committee to ensure that work is done in and across all Departments so that every Department is conscious of the need to implement child protection policies. This work is under way.
We also have a lot of work to do in developing and establishing a national child protection register, as well as developing consistent risk assessment, which applies across the whole health sector, and measurement tools. A greater focus on quality assurance and auditing of workloads is also required. We must also prepare and implement a workforce development plan for child and family services. We intend to develop the important implementation of national standards for preschool services. An out-of-work social service is a key priority for this year.
I look forward to working closely with Mr. Gordon Jeyes, the HSE's national director of child and family services, to deliver on the areas I have referred to. It is an ambitious programme of work and will significantly strengthen policy, legislative and practice frameworks in delivering the range of services I have outlined. It is not good enough to continue services as was done in the past. The various reports I mentioned have illustrated the failings involved and, thus, the need for change. I acknowledge the work that is being done around the country by the dedication of the many staff involved in this area. It is a demanding area in which to work, involving huge demands and increased financial pressures. In that context, staff have to deliver a quality service to children and families who come to them for help. It is challenging and demanding but the Government has the will to meet that challenge. I have the support of my Government colleagues to deliver the programme as outlined for the House.
I have a good deal of understanding for the predicament the Minister and her colleagues are in as she tries to grapple with the crisis in our health care system. In this regard, the Minister was handed a poisoned chalice by the previous Government. I am not sure, however, that the Minister and her colleagues are aware of the real fears Irish people have as they contemplate the future. I am sure that Government backbench Deputies are aware of what is happening to our health care services because they are hearing about it in their clinics. Nonetheless they seem to have adopted a Trappist vow of silence and are not reflecting the views of their own constituents.
Not alone is the health system in crisis, but it is also an apartheid system. We still have the awful phenomenon where ability to pay can determine the speed of access to health care services. That is an apartheid system which is simply not good enough. Sinn Féin seeks to create a democratically accountable, national health service that is responsive to the diverse needs of the population as a whole, and that is flexible enough to provide the highest quality care appropriate to individual needs. However, we currently have a health care system that is in crisis and there is very little leadership. We hear much talk of change but see no evidence of it on the ground. In addition, there is very little accountability and only vague promises of change to resolve the myriad problems that are arising.
In the constituency I represent, Sligo Leitrim North, there was an outcry when breast cancer services operating to a very high standard at Sligo General Hospital were withdrawn. There must be a re-examination of the cancer control strategy. We still have ill people from Donegal, Leitrim and Sligo travelling to Galway and back, which is not a good service. The policy must be revisited and one of the key aspects of it must be access to the service. There is a lack of stroke service facilities at Sligo General Hospital, which was promised but never happened. We were promised a mammography service would be restored to Sligo General Hospital by the end of last year but that has not happened yet. There have been myriad resource and staff cutbacks for acute hospitals. Staff in hospitals may not be telling the Minister this but they tell me that when someone is sick, is on maternity leave or retires, staff are not replaced. The staff are beyond stretching point.
Our Lady's Hospital in Manorhamilton has an excellent regional rheumatology service. Two consultant rheumatologists provide an outstanding service and relieve many patients of severe pain. One is going on maternity leave and cannot be replaced because of the staff embargo. Waiting lists of one year will extend to two years and no human can say that to leave someone with acute arthritic pain for two years without a consultant is a good service. It is a disgraceful service and we deserve better.
There are threatened cutbacks to longstay nursing homes throughout Sligo and Leitrim and real fears that nursing home beds will be closed because, allegedly, the nursing homes cannot provide a gold standard service due to lack of finance or human resources. People who should not stay home will do so because the gold standard is not available in public hospitals.
The most insidious of all is the threatened reduction in the number of home help hours. It is the most effective and best value service in the range of health care services. Home help hours have been reduced and non-replacement has also been threatened with regard to critical front line staff who will retire in great numbers at the end of this month. We do not yet know the impact. The public dental services are virtually non-existent in the area.
The CEO of HIQA was invited to attend a meeting of the Oireachtas Joint Committee on Health and Children two weeks ago and acknowledged the growing challenge of ensuring quality while slashing expenditure in public health care services. At some stage HIQA and the people must say that enough is enough. If health care was a passenger aircraft, we would have been called in long ago by the Irish Aviation Authority and grounded due to safety concerns for passengers. I refer to the shambles that surrounds the centralisation of processing of medical card applications. People who are desperately in need of medical cards must wait months instead of weeks for eligibility decisions. In the meantime, they cannot afford to pay a GP, they cannot afford prescriptions and other essential medical needs. An increasing number of people are marginally outside the eligibility guidelines. People with chronic illnesses are being turned down and it is a mathematical calculation used with no reference to illnesses.
Several years ago, I heard my party colleague, Deputy Caoimhghín Ó Caoláin, speak about death by 1,000 cuts in health services. The cuts are getting deeper and the wounds are fast approaching the point of no return. There is an alternative to this. Sinn Féin promotes a new universal public health system that provides care for all, free at the point of delivery on the basis of need alone and funded by general, fair and progressive taxation. That can still be done. There must be a fundamental reorientation of the health system to adopt a central focus on prevention, health promotion and primary care, including mental health care. Ultimately, we must eliminate the underlying social and structural causes of ill-health and premature death, such as poverty and inequality. We need a reorientation and roll-out of the promised primary care centres throughout the State on an accelerated timescale. Decisions about acute hospitals are being made on the pretence that primary care has improved. That is fiction. Decisions on cutbacks in acute hospitals made in advance of improvements to primary care only reduce the choice and increase the timescale for sick people getting into hospital when they need it.
Has the Minister of State wondered why thousands of people entitled to receive public health care in acute hospitals pay increasingly big bucks for private health insurance? The reason is that they do not trust the public health care system. They feel the public health care system will not be there for them and their families when they need its services. People prefer to see money invested in health care and the education rather than to increase the income of greedy financial gamblers and zombie banks. Quality health care is a labour-intensive industry and cannot be done on the cheap. People would not mind paying fair taxes for a quality, one-tier health care system, provided it is delivered fairly, efficiently and effectively. Health care needs will increase over the coming years and decades. It will not decrease because we have an increasingly elderly population. Access to quality health care is a right, not a privilege that can be withheld at the whim of Government, the troika, the EU or anyone else. We cannot continue to deliver a quality service at bargain basement prices. There must be a baseline, below which we cannot go. We have fallen below the baseline.
I propose to share time with Deputy Mulherin. The budget provision for 2012 will be a major challenge for the HSE and comes at a time of significant reform of the public health system. The total cost reduction in 2012 will be €750 million. At the end of 2011, the employment control framework target for the HSE is 105,300. The HSE estimates that the actual number employed at the end will be 104,500, some 800 under the ceiling. There is also a plan to provide for the recruitment of about 400 staff from mental health services on foot of the additional €35 million in expenditure. The closing date for retirement applications has arrived and some 3,700 staff have retired in the period from September 2011 to February 2012. A contingency plan has been developed at the local HSE level in the context of the national and regional services process. All regional plans are being developed on the basis of anticipated numbers of staff.
On Monday, December 2011, I as a member of the Oireachtas Joint Committee on Health and Children, called on the Minister and chief executive of the HSE to make the situation regarding possible nursing home closures clear as soon as possible. I also expressed the concern of the people of Louth about the possible closure of the nursing home in Drogheda, the Cottage Hospital, and St. Joseph's in Ardee. Since that request the Minister has met with both nursing homes and given them options and hope, which I appreciate. Both have also had meetings with the HSE. St. Joseph's Hospital has received a promise from the HSE that an appraisal will be done by the end of March. It has also agreed to meet on 24 February 2012 to give the hospital an updated progress report.
I refer to the special delivery unit, SDU. Its priorities have been set by the Minister, Deputy Reilly. The first priority is a reduction in the number of patients spending long periods of time on trolleys and the second is the reduction in the number of people on the inpatient waiting list. As can be seen by recent results, this is happening. It is worth noting that 15 hospitals are responsible for approximately 80% of the trolley waiting list and if we look further we find eight hospitals were responsible for almost 60% of the problem.
The SDU has spent a considerable time analysing the problem in our hospitals and has had latitude to consider the situation on a multi-hospital basis. Each of the relevant eight hospitals was invited to the SDU to seek support under certain headings. The requested support has been analysed by the SDU in consultation with the HSE.
In the case of Our Lady of Lourdes Hospital in Drogheda, the hospital has requested a range of support and the SDU has agreed to a set of proposal at a cost of €725,710. The main measure of approval for the hospital was to extend the AMAU to 18 hours seven days a week; open eight medical beds in Drogheda; open an additional 28 low acute beds in the Louth county Hospital in Dundalk; open an additional 27 low acute beds in the community; and organise additional long-term beds.
I was glad to hear the Minister, Deputy Reilly, say today that he had plans for the future of the Louth County Hospital in Dundalk. It is a minor injury unit, open from 9 a.m. to 8 p.m. daily. There is an attendance fee of €100 but patients referred by GPs or who have medical cards are exempt from the charge. There is a stroke and rehab unit and palliative medical ward in the hospital. Day services include a haemochromatosis clinic, an elderly assessment unit, a cardiac rehab unit, cardiac services, pre-assessment clinics, a diabetes day centre and a heart failure clinic. The outpatient clinic includes general medicine, gynaecology, antenatal care, paediatric care, orthopaedic care, vascular care and a warfarin unit. It also has physiotherapy services, a radiology department, CT services, ultrasounds, occupational therapy, laundry and theatres. It has outstanding facilities and I thank the Minister for his help.
In response to Deputy Colreavy, not a day goes by that the enormity of the tightrope being faced in the delivery of health service is not starkly clear to me and the Minister of State, Deputy Lynch, the Minister, Deputy Reilly, the Minister of State, Deputy Shortall and the Minister, Deputy Fitzgerald, who are involved in this area. They hear a large number of stories and have much with which to contend. There is also the human side of wanting to give a service to people, which is overwhelming.
We know the system is crying out for reform and efficiencies. Aside from our economic crisis, the most pressing area is health because we cannot choose when we become ill, are dying or have a disability. It is a time we would like to think help is available and the State is there for us. Illness does not discriminate between those from poor or wealthy backgrounds. People want the service to be in place. It is important that we reform the system. It is the most difficult area and one which frightens me.
The Minister, Deputy Reilly, has made a clarion call which he wants to follow through on. Let us be under no illusion. There are many vested interests who do not want anything to change and do not want to address efficiencies, and we know why. People do not want to change job practices and so on. These realities are faced every day. The system will not change overnight but if we steer the ship in the right direction it is to be hoped we will end up at the right destination, which is the objective.
The talk is about efficiencies, reform and so on. If one looks at how sub-areas in the HSE are trying to react, one will find efforts are being made in local areas. I can speak for my area in particular. There is a district hospital in my town which is considering closing beds because of a lack of staff. A solution which has been applied in St. John's Hospital in Sligo is being considered. The hospital might bring in home helps to help with cleaning, which would alleviate staff to support nurses and keep beds open. I am very hopeful that will happen. Unions have to be very responsible in encouraging people to be flexible and responsive so we can deliver health care under the constraints that exist. Nobody is losing his or her job, people are being asked to be flexible.
In terms of efficiencies being achieved, since this time last year there has been a reduction of 70% in the number of people waiting on trolleys in Mayo General Hospital. The national average is 20%. All the efficiencies, green lights and health statistics have brought the hospital into the top five list of efficient hospitals in the country. I commend the hospital manager, Charlie Meehan, the HSE manager, Frank Murphy, and the staff and management who are working together to achieve efficiencies through the reconfiguration of medical and surgical beds, increasing the number of day cases and a more efficient use of step-down facilities.
There are also plans in the pipeline which, it is to be hoped, will come to fruition to extend the renal dialysis unit and build a cystic fibrosis unit. There is also what I believe is a unique initiative, the lean academy. People working at management level in multinational companies in Mayo work with hospital management on the leaner and more efficient delivery of services. We are getting the know-how and expertise from people in multinational companies who give their time voluntarily to try to achieve efficiencies.
There comes a point when people hit a wall. The reality is that even if we are achieving efficiencies we are contending with a moratorium. At some point soon we will have to consider replacing front line staff. We can have all the fine structures we want but if we do not have nurses to look after people in bed we will not have a service. Without a doubt, anybody speaking truthfully would say it is a problem. The problem is the economic crisis in the country. The patient has to be of paramount interest and has to be what motivates us, and there should be an alarm bell when that is not happening.
There are many ways in which services can be delivered and they are being explored. Just because they are not under the traditional heading of how services should be delivered not mean they cannot be delivered in another way. It is a serious challenge. There are delays in people in getting approval from exemptions to the moratorium, ranging from a year to 18 months. If we are serious about exemptions they should be delivered.
The fair deal package is unsustainable and we have to consider other ways of allowing people to be cared for in their homes. People should only need to go into homes for medical reasons and should be supported in their old age, no matter what disabilities they may have. It would be a lot cheaper to give incentives to people to give up work, stay at home and still get a stamp.
I wish to share time with Deputy Maureen O'Sullivan.
Is that agreed? Agreed.
There are several things at which we are very bad in this country, one being the building of institutions. We have no history of doing so and we inherited our education, local government and health systems. When the latter was reformed, it was not really reformed. What happened is that the HSE was lobbed in on top of the health board system, and the oversight role of councillors was removed. There was never any real reform. Reform presents a big challenge, which I fully acknowledge. The challenge has been inherited by the Government at a very difficult time.
There are very many excellent people working in the HSE who are going way beyond the call of duty. Let us not put everybody into the one basket and engage in a blame game because doing so is unfair, demoralising and counter-productive.
Let me refer to the service plan. People are appalled at the lack of targeting in the downsizing approach. There is some very blunt language in the document. I have been saying for the past few months that it does not make sense to make staff redundant through early retirement and then recruit others. This does not result in a saving; it shows a lack of certainty in the Government's approach. This is not helpful at all and it could end up being very costly in the long run, or more costly than is necessary.
We are told much efficiency has been achieved and that it is not possible to protect services from reductions in 2012. There are some very serious developments on the way. The plan states "hospital budgets will drop on average by 4.4% of last year's allocation". When deficits are taken into consideration, this is closer to 8%.
The document indicates how threadbare and unbalanced the system is. It states the western hospitals are particularly challenged. Some services, such as speech and language services, are monumentally better in some parts of the country than in others. Why should one's address determine the quality of the service one receives?
We are told the reorganisation of the ambulance service is required, yet we are told there will be no additional funding in 2012 and that our ability to address the newly agreed national targets will be challenging. The phrase "will be challenging" is seen throughout the document. "Challenging" means very little or nothing will happen.
I have a number of concerns. The approach involving keeping elderly people at home is good but there is to be a major change in regard to home help for personal and non-personal care. I refer to home helps who call to people to see whether they are okay. Has there been an actuarial assessment in the past year of the income that might derive from the fair deal scheme?
With regard to mental health, which is the responsibility of the Minister of State, Deputy Kathleen Lynch, the sum of €35 million is very welcome, but there is a considerable drop in the number of psychiatric nurses owing to the retirement scheme. It has been said to me several times, and to the Minister of State, that if we took mental illness and suicide as seriously as we take road safety, it would be beneficial. The Road Safety Authority's statement, which I examined today, refers to a sum of €48 million. The authority has been doing an excellent job in this regard.
If we were to consider the effect of a really targeted approach in the area of suicide prevention, we would consider changes in the institutional provision of mental health services, given that the money is not be shoved towards another service. I am sure there will be good oversight on the part of the Minister of State.
The HSE has been allocated €40 million each year for ICT projects. This is a lot of money and it is very welcome but there needs to be institutional architecture if a proper ICT system is to be built. Without this, computers and systems will not talk to one another and one will end up wasting money and with incredibly wasteful systems such as PPARS. It is essential that we see the institutional architecture before we commence. We will have to have oversight. There are savings that can be made and greater efficiencies to be achieved in our approach but let us not proceed in a haphazard way. Let us put a health system together that is integrated.
There are many points in the plan about which I am very critical but if I were to elaborate on them I would be told off by my colleague, Deputy Maureen O'Sullivan, for taking up her time. I am sure she will cover some of the other aspects.
This year presents a major challenge for the HSE in that it must do more with less. There is a massive budget, however, and if it were spent in the most productive way, it would surely produce a high-quality and proper health care system. The plan states "Designing and delivering services, to ensure high quality safe services for all our patients and clients, is our primary concern". Central to this is the dignity of the person, irrespective of whether he has a mental illness, disability or physical illness.
Some time ago, the Technical Group sponsored a motion on mental health during Private Members' business. It was one of the most moving debates in my short time here, three years. The Minister of State, Deputy Kathleen Lynch, was present and contributed to the debate. It demonstrated that mental illness has touched so many people. We are told one in four will be affected, yet the HSE's budget in this area is only 5.3% of its overall budget. While I know the Minister of State is doing her best, the figure is very low.
We cannot talk about this topic without mentioning Mr. John McCarthy, who passed away recently in Cork. He had mental health issues. At the core of everything he did was an emphasis on the dignity and rights of those suffering from mental illness. He was a phenomenal and tireless campaigner in highlighting the normalcy of madness. Members will know about Mad Pride Ireland. I hope that, in memory of Mr. McCarthy, we will get rid of the involuntary use of ECT.
The plan states 414 extra posts will be funded from the €33 million. With so many leaving the health service, will the new staff be replacing those who leave or will they be additional staff?
They will be additional.
That is to be welcomed. I acknowledge the positive incentives, the multidisciplinary mental health service teams, the child and adolescent community teams, the inpatient units and the ensuring of access to quality psychotherapy and counselling services. People need these and they should not cost a fortune.
Deputy Catherine Murphy referred to suicide prevention. I mentioned previously Oasis Counselling Centre in my constituency, which centre is part of the Deora project. It is a small well-managed project and allows for direct access for those in difficulty, particularly those presenting with suicidal tendencies and addictions. Many counselling services will not take on people who are suicidal if they are also experiencing addiction.
Another example of best practice is St. Michael's House. It deals with very vulnerable people. It has a well-focused budget that is not wasted on administrative expenditure. Sometimes the micro can inform the macro, rather than the other way around.
The staff losses in the public sector will present a major challenge. The Taoiseach referred this morning to personal choice but this choice was encouraged by financial incentives, resulting in the loss of much expertise and knowledge. Those with knowledge and experience should have been incentivised to stay. The scheme ought to have been phased rather than establishing a specific date in February.
The risk assessment and impact study should have been carried out before the event and not afterwards. A voluntary group to which I belong asked us before the budget to examine the consequences of cuts of 5%, 10% and 15%. We had the answers on how to cope with each of these. Delivering a high-quality service depends on having a high-quality staff. The plan refers to "new models of care" as a means of obtaining more from the reduced budgets, but there is detail missing in this regard.
I very much welcome the dedicated subhead in the Estimate pertaining to children and families. The funding for prevention is vital. It was interesting to read the section on promoting and protecting health. This relates to health inequality. There is a clear link between socioeconomic status and health behaviour. Emphasis must be placed on prevention. The longer young people stay in school, the better their health options. We must not cut education expenditure and preclude them from staying in school.
The health responses to drugs and addiction have been generally included in the social inclusion and care group but they need to be identified clearly in respect of mental, primary and population health. This means the clear inclusion of alcohol in the national substance misuse strategy. The publication of that strategy is necessary because alcohol and other substances have a considerable impact right across the health service.
A young man who was suicidal and had an addiction tragically committed suicide when, on becoming 18 years of age, he was transferred from an excellent youth service to an adult unit. The system has to work for the person, not the other way around. In my constituency, the fifth person in a family was buried yesterday as a result of drug addiction. These are the issues we have to tackle.
I wish to share time with Deputy Kieran O'Donnell.
Is that agreed? Agreed.
I welcome the opportunity to speak on the HSE service plan for 2012, in particular as it relates to my own constituency, Cork North-West, and the HSE South area. There is no doubt it is a challenging time to deliver health services, with a reduction of €750 million in funding for the HSE for 2012. However, it is a challenge which, with goodwill, we are capable of rising to. There will still be in excess of 100,000 staff charged with the responsibility of delivering a package of health services across critical areas such as community care, acute hospitals, mental health services and a host of other areas, including services for people with disabilities. If we can park the politics and point-scoring and address how we can use the very significant financial resource, we can do more with less funding, particularly if there is a willingness to do so across all areas of service delivery.
I want to particularly address the issue of care of the elderly, which is one of the issues that has received much media coverage recently. As a result, there is much anxiety among that section of the community about, in particular, community nursing units. I am glad there will be no closure of any of the community nursing units in the HSE South area, notwithstanding much public comment to the contrary from people whom I sometimes wonder might wish there would be closures so they could make more political capital out of it. I recently attended a meeting in Macroom on the issue of the local district hospital, and I am glad to say it will in 2012 continue to deliver, as it has in the past, an excellent service in the community it serves, as will other hospitals in my constituency such as those at Millstreet, Kanturk and Dunmanway district hospitals.
Notwithstanding this, there are critical issues we need to address. The fundamental issue is that it is cheaper for the State to buy beds in private nursing homes than it is to fund them under the current regime in its own hospitals. Interestingly, I received an e-mail today from the Impact trade union, as I am sure other Members did. The Impact e-mail made reference to the fact the Croke Park agreement was delivering and stated that one recent example has been finalised at Our Lady's Hospice, Dublin, where changes to rosters and breaks are expected to deliver annual savings of €220,000. The e-mail stated that the changes will free up 3.5 staff members to work elsewhere in the organisation, leading to an annual €175,000 reduction in spending on locums and agency staff, and a further €47,000 will be shaved from spending on premium payments which reduce earnings for staff concerned. Bravo.
The real challenge for the HSE management, however, is to get into the trenches. Why is this information from Impact newsworthy? It is newsworthy because it is not happening across the sector and is an isolated example. HSE management will have to get into the trenches in terms of negotiating issues such as overtime rates. It would be far better not to cut the amount of overtime hours and to instead cut the rates and protect the service. Premium payments, overtime rates, rosters - if all of these issues were addressed uniformly across the service, developments such as have happened at Our Lady's Hospice in Dublin would guarantee the future of public health nursing units throughout the country.
Given their cost base, such units are now under close scrutiny. I would encourage staff representatives, unions and management at local level to get into the trenches in terms of negotiating the cost base and ensure that these units are viable. It will not serve the public interest in the long run to place all of our eggs excessively in the private nursing home basket because once we have done that and closed facilities, we will be held to ransom by the private nursing home sector. It is an issue that needs to be examined.
We need to consider the appropriateness of placing people in long-stay facilities, whether private or public, given there are intermediary care options which are less expensive. The optimum solution for as long as it is practical is to keep people in their own communities. However, providing people with assisted living is capable of providing a far more cost-effective option to the State as opposed to inappropriately placing them in either community nursing homes or private-run nursing homes at greater expense to the State.
There is a challenge ahead in terms of meeting the reduced budget but it does not necessarily have to mean a straight line reduction in services across the board. It is a challenging time. I urge all sides, in particular union representatives and management, to get into the trenches in terms of ensuring that Croke Park delivers. Otherwise, there will be very harsh consequences for consumers of services as well as for those working in the service.
I want to discuss the issues that pertain to my own constituency, in particular Limerick city and the mid-west, and in particular given the difficulties in accident and emergency services. The 24-hour accident and emergency service is now provided at Mid-Western Regional Hospital, Limerick, and a 24-hour service is no longer provided at Ennis and Nenagh hospitals. This was part of the reconfiguration process that commenced in 2009 and brought a large extra number of people through the doors of the accident and emergency unit at Limerick regional hospital. At the time, the money did not follow the patient and extra work was being carried out by the accident and emergency unit in Limerick.
Relative to other regions, the mid-west has not fared well, which is an issue I have raised consistently in recent times. I welcome the fact the Minister, Deputy Reilly, appointed a special delivery unit specifically to deal with Limerick regional hospital and allocated specific funding of €250,000 towards the end of last year. I further welcome the fact Ms Ann Doherty has been appointed by the HSE and the Minister as manager of the Mid-West Hospital Network, which effectively covers Limerick regional, Ennis and Nenagh hospitals. This shows the mid-west is getting the attention it deserves.
One of the consequences of the early retirement scheme for public servants is that people will be leaving the system by the end of February. We note media reports that 47 midwives out of a complement of 200 at Mid-Western Regional Maternity Hospital have indicated they will be availing of the retirement scheme. While we do not know the specific figures, that is the indication. This means over 20% of midwives in the hospital are leaving, which is a worry. Some 5,200 babies are born there every year and 6,000 women avail of maternity services. I note the Minister, Deputy Howlin's commitment that the issue of a lack of staff resulting from the retirement package will be given priority.
I ask the Minister to give top priority to the maternity hospital in Limerick. We are all parents. My four children were born at Mid-Western Regional Maternity Hospital, which provides excellent care and has terrific staff at both consultant and nursing-midwife level. I pay tribute to the work they do. This issue has been flagged early enough that it can be addressed by the Minister and the HSE, so we can have a sufficient compliment of midwives to ensure services are delivered.
On the overall issue of funding for the mid-west, when reconfiguration happened in 2009, the region was supposed to get extra funding for services at Limerick regional hospital but sufficient funding was not delivered. I am aware we live in difficult times. However, the mid-west and Limerick are entitled to fair consideration. Relative to other regions in the country, we have fared badly. I worry that the region will be penalised for making savings. Rewards should be given for efficiencies. Efficiencies have been driven in the mid west and Limerick over the past six months, if not longer.
I got a commitment from both the Minister for Health, Deputy Reilly, and the head of the HSE, Mr. Cathal Magee, that a review would be carried out in respect of funding for the mid west and I understand this is currently underway. As a Deputy for Limerick city, it is my view that we are entitled to our fair share relative to other regions in the country. We are looking for no more, no less. This is something I will continue to highlight.
Much great work has been done by the Minister, Deputy Reilly, and his colleague, the Minister of State, Deputy Kathleen Lynch, as they look to reforming the health service. Limerick has undergone rapid change in the recent period and we must ensure we have sufficient funding and personnel. That last is clearly given emphasis by the 47 midwives who are leaving by the end of February under the early retirement package in the public sector. I want a commitment to ensure there will be a sufficient complement of midwives at Limerick Regional Hospital on the Ennis Road, starting in early March. That is critical.
I call Deputy Charlie McConalogue who has ten minutes.
I welcome the opportunity to speak on the HSE service plan for the remainder of 2012. It is disappointing that only at this stage, on 1 February of the year covered by the plan, are we debating and discussing this service plan.
If we look at how the plan is drawn up, we see that following the budget each year, including this year, the HSE has three weeks with which to furnish a proposed service plan to the Minister for Health. After that the Minister has three weeks to accept and approve that plan. I do not find this a reasonable or sensible way to run a health service, when only in the month of January does the HSE sit down with the Minister for Health for his approval of its service plan for that very year.
There was the charade in the early part of January when the Minister referred back to the HSE the draft service plan it had provided to him, stating he was unhappy with it. This is the same Minister for Health who abolished the HSE board shortly after taking up power. He told us he was taking charge and things would be very different under him. We had the spin of the Minister sending the plan back to the HSE. As one journalist pointed out, very appropriately, it was like sending a letter to oneself to complain about oneself. It was no more than that.
This service plan would be better described as a service reaction, a HSE service reaction to the budget it was given in December when the Minister for Finance, Deputy Noonan, outlined exactly what would be available for services for the coming year. Rather than bringing in the budget and sending it to the HSE asking it to outline what it will do with it, a much more appropriate way would be to liaise and link closely with the HSE. I would expect that in the future - I expected it this year. It should not be so difficult, considering the Minister is not only the Minister for Health but has also taken over the running of the HSE board. He could then tease through with the HSE exactly which services can be delivered in the year ahead alongside the particular budget lines given by the Minister for Finance.
Instead the budget is made and the figure given to the HSE which is then expected to come back and say what it can do with the money. This is very similar to what we have seen in the approach to redundancies, for which the deadline closed yesterday. Instead of indicating clearly what was being sought, which Departments might be exempt and which areas of the service might manage with fewer staff, there was an across the board opportunity for anybody who wished to retire, regardless of whether the HSE or the Minister believed they were needed. The only exemption given so far was to the Director of Corporate Enforcement, yesterday. He has been kept on. That is not the way to reform but at least it is consistent with the way we have seen this service plan being drawn up and implemented in the past year.
What have we seen in this plan? We have seen €750 million cut from the health budget this year and 3,300 staff due to leave the HSE during the course of this year, on top of the staff who left last year. In 2012, hospital budgets will drop on average by 4.4% from last year's allocation. This will require an expenditure reduction of 7.8% in many hospitals where overruns are being taken from the previous year. The Minister states he expects activity levels to fall by 6% as a result while the HSE believes it can keep the figure down to 3% by reordering the way it provides service. Even so, we are talking about a 3% activity drop which means less service being provided and fewer patients being treated. An activity drop means more patients waiting longer for treatments they eventually will have to have but before which they must endure, in many cases carrying their illnesses and pains around with them while they wait for their treatment.
I had direct experience in my own county with the Minister as to how this measure will impact. Letterkenny General Hospital, which serves the wider Donegal area, is calculated by the HSE to be the second most efficient hospital in the country. Nonetheless its budget has been pared back. It is in a unique position in that 90% of the treatments it carries out are non-elective. In other words they have to be done and the hospital does not have discretion to decide on them. As the budget is increasingly pared back those treatments for which one might say there is discretion, such as hip replacements, orthopaedic care, outpatient appointments, are knocked back further and the patients concerned must wait longer.
In the past year we have seen, as each Deputy in this Parliament will have seen, that many patients in that category are now waiting longer than ever. Since the National Treatment Purchase Fund was done away with, patients who, until then, would have been able after three months to access that fund and have their treatments carried out, are now, in many cases, waiting more than a year. The Minister tells us he does not want anybody to have to wait longer than nine months. That nine months is three times longer than patients had to wait when the NTPF was available. I have no doubt that other Members will have had the same experience as I have, seeing strapped families having to come together to purchase private treatment for a parent or a grandparent who simply cannot wait any longer to have it done.
The budget will also affect community hospitals. Although the Minister told us at the end of last year that he did not want to see any community hospitals closed, shortly afterwards the first began to close. This year up to 900 beds will be taken out of community hospitals. As Deputy O'Donnell pointed out earlier, patient care will naturally cost more when beds are taken out of a hospital. Overheads will be similar but the number of patients is reduced. That is then used as a rationale for arguing it is cheaper to provide this service in private hospitals leading to the shutting of the community hospital entirely. It makes no sense to close any more beds in community hospitals. The Minister needs to revisit his decision in that regard.
Budgetary cuts are inevitable in our current economic environment. However, health and education must have first priority in protection from cuts. Will the Minister show us more of the evidence of how he is going to reform the health service? So far, all we have seen are longer waiting lists and hospital beds closed. Instead of everyone receiving universal health insurance, as the Minister claimed when he took office, fewer people have private health insurance now resulting in more pressure coming on to the public health system. I cannot support the health service plan 2012 and am disappointed with the results in health service reform so far.
I welcome the opportunity to contribute on the Health Service Executive's national service plan 2012. I support Deputy O'Donnell's call for the need for a fair share of funding for HSE mid west, particularly when one considers the savings the agency made in the region over the past 12 months.
This is a challenging time for everyone working in the HSE, health service users, patients and their families. This plan has been laid out against the background of up to 3,500 impending retirements from the health services when it is anticipated 7,700 public servants will avail of the overall retirement scheme. However, it is important to remember between 5,000 and 6,000 health services staff retire in a normal year and that the majority of those leaving by the end of this month are within 12 to 18 months of their normal retirement.
Listening to Fianna Fáil Members, one would believe the introduction of the incentivised retirement and this scheme came as a surprise to them. It was during their watch in government that the moratorium on recruitment was introduced in the first place. It was the former Minister for Health and Children, Mary Harney, who introduced the voluntary redundancy and retirement scheme in the HSE which, at the same time, was aimed at reducing the number employed in the public sector from 2011 onwards.
No Member will dispute the review of pension arrangements for serving public service staff poses challenges for the HSE. It does, however, provide an opportunity for real public sector reform. While it is difficult to confirm the final figures given that each employee has up to the last day of February to change his or her mind, the HSE has a clearer picture of where to plug the gaps in services through either personnel redeployment, savings efficiencies in other areas and limited targeted recruitment.
Despite a reduction of €750 million, funding is still significant even in these difficult and challenging times with the health budget this year standing at €13.3 billion. As the Minister for Health rightly said earlier, reform is no longer just an option, it is an essential requirement for all involved in health service provision. The Minister is a reforming one. Being a medical practitioner he knows the health system inside out. Already, in his short time in office, he has achieved much with the introduction of the special delivery unit. The statistics prove this. The number of people on emergency department trolleys at 8 a.m. for the first 16 days of January 2012 stood at 5,046 when it was 6,893 during the same time in 2011, a reduction of 27%. The Government is driving health service reform.
Finding new innovative ways of delivering our health services is essential in minimising the impact on reduction in resources for the patient. The HSE is capable of adapting to the changed economic environment. Today, I was pleased to be informed that following the review of the long-stay nursing homes in the mid-west region, no nursing homes will close in County Clare. There was much scaremongering by some Opposition Members on this matter. I am happy to reassure the patients, their families and the staff of Regina House, Kilrush, St. Joseph's Hospital, Ennis as well as Raheen Community Hospital in Tuamgraney and Ennistymon Community Hospital that their doors will not be closing. I pay tribute to the management and staff in the non-acute section of the HSE for making this possible even with a reduced budget. It was confirmed to me this evening by the HSE and the Minister's office that there would also be no bed closures. We must, however, remember no further bed closures will depend on staff leaving the health service and changes to sick leave arrangements as well as other work arrangements.
I thank the Minister for Health, Deputy Reilly, for his support on this matter. I had lobbied both him and the Minister of State, Deputy Kathleen Lynch, on this on many occasions. I know their preference is to see as many old people to live in their own communities. That is, however, not always possible.
I welcome the additional provision of €35 million for mental health services in this year's plan. This is important as it is estimated that over 300,000 people suffer from depression, a startling figure. The development of specialist day-care centres can play a pivotal role in reducing the need for long-stay beds in acute psychiatric services.
More than 4,000 people are identified with dementia every year and it is reckoned by 2040 it will affect up to 147,000 people. Many of these patients are cared for by their families and friends at home but also they can avail of day-care services. As well as the outstanding social interaction value the centres provide, it is a source of comfort for families to know their loved ones are looked after in a safe environment for several hours during the day. I hope more of these facilities will be built in our communities because they have a valuable role in the development of care for the elderly allowing them to live in their own homes for longer, which is what most people want to be in a position to do.
Last Monday I spoke at the launch of the new Sikorsky S-92 helicopter at Shannon Airport. The helicopter's primary role will be in search and rescue operations along the west coast and it will be a great asset to the Coast Guard's helicopter rescue crews. It is capable of operating in all weather conditions and its auxiliary fuel tanks allow it to travel extended distances. However, it is also ideal for providing the HSE with air ambulance services. The crew members, most of whom are trained paramedics, told me they will be able to travel from Shannon Airport to parts of west County Clare, such as Kilbaha and Carrigaholt, in 20 minutes. That will help people in disadvantaged areas. I understand negotiations are ongoing between the HSE and the Coast Guard and I hope the air ambulance service will be up and running by July, which is welcome news for people who live in rural, isolated parts of my constituency and tourists who visit the county during the summer. The air ambulance service will be assisted by advanced paramedics on the ground, about whom I hear positive reports. I acknowledge the work they do in covering the county on a 24/7 basis.
I have insufficient time to speak about the testing for type two diabetes which the HSE is rolling out. We are living in unprecedented times and we face major challenges with our reduced health budgets. Ministers have to cut their cloth by their measure. A significant number of experienced staff will retire next month but the staff remaining in the HSE are well trained professionals and while the departure of their colleagues will pose a challenge, they can reduce the impact on front line services by working together.
I call Deputy McLellan, whom I understand is sharing time with Deputy Nulty.
I welcome the opportunity to speak on a matter with far reaching implications. It is impossible to address the financial constraints within which this service plan was drawn up without mentioning the Government's economic policy. At least €750 million will come out of the HSE's budget this year, following two years in which a total of €1.75 billion was removed. Staff levels are down by over 8,700 since 2007, while demand on services continues to grow. This is happening even as the Government willingly pumps billions of euro into the cavernous remains of Anglo Irish Bank in an attempt to keep international onlookers satisfied that we can behave ourselves. We went mad all right, but just for a while. We hope and pray that a European recovery will raise all boats. It is subservient economics 101 and the population at large suffers.
The dance that took place to get us to this point is telling. Starting with the Minister's kite flying in advance of the budget, the rejection of the earlier version of this document and the early new year media intervention, it looked and sounded like damage limitation. The details of the plan indicate why damage limitation might be an appropriate course. It is a plan that is difficult to accept and even more difficult to believe. It contains a litany of ambitious targets, many of which are to be welcomed, such as those relating to efficiencies and performance. However, other targets will have a detrimental effect on the quality of life of thousands. In a year that will see €750 million taken out of the system, equating in some instances to a 7% or 8% cut, I wonder how the Minister, his Department and the HSE expect to achieve these targets. Sound bites about working faster, harder or better will not be enough.
The headline issues arising from this plan have been highlighted. It is clear that the heart will be torn from our public nursing homes. The plan states:
The challenges associated with the continued provision of residential care in public facilities as a result of staff reductions and the National Standards for Residential Care Settings for Older People in Ireland will lead to a continued reduction in the numbers of public beds in 2011. In the absence of reform, this would increase the cost of caring for older people within the public system, undermine the viability of public community nursing units, and reduce the overall number of older persons that can be supported within the budget available for NHSS. It is anticipated that a minimum of 555 residential beds will close in the course of year.
The figure could be as high as 1,000 beds, however.
We have already seen the ball starting to roll in Laois, Athlone and Dublin, to name but a few areas. In my area of Cork East, facilities and beds are under threat in Youghal and Fermoy. Youghal Community Hospital is in danger of losing eight beds, with the result that vulnerable elderly people and their families are left at their wits end. Home help hours are being cut at the same time as the State seems to be abandoning its duty of care. The work carried out in our local public nursing homes by carers and community nurses is essential. This national service plan will see a further erosion of this service.
Likewise, an aspect of the health service which has gained prominence in my constituency and, indeed, in the entire Munster area over the past 12 months is the so-called reorganisation of pre-emergency care. Ambulance response times for 2011 were below target across the board yet the HSE somehow expects to improve the system by redeploying the same staff over longer periods in less sophisticated vehicles. Rural areas are up in arms. Youghal has been fighting for the retention of its ambulance service in the face of proposed downgrades. The plan as outlined will cost lives and needs to be resisted. I commend the work of the Save Youghal Ambulance Committee in this regard.
The percentage of clinical status one echo incidents responded to by first responder vehicles in eight minutes or less was 49% last year, compared to a target of 75%. This year's target of 75% seems to be arbitrary. A mere 26% of delta cases were responded to in the same period. It appears the target figures were plucked out of the air with little or no consideration for what the service means to people.
I thank Deputy McLellan for facilitating me in contributing to this important debate. The health service plan leaves no question that taking €750 million from the HSE's budget will have a devastating impact on our health service.
We have choices on meeting our international targets while at the same time protecting health and education. Abolishing property based tax loopholes would yield an additional €450 million this year and increasing capital gains and acquisitions taxes to 40% would yield approximately €250 million. These are political choices the Minister for Finance could have made to provide extra money for health services. I regret that, despite the advice of many groups and economists, those alternatives were not taken.
At the end of this month, 1,739 nurses will leave the public system. This will inevitably result in further bed closures. More than 2,000 beds have already been closed across the country. Further bed closures will have a knock on effect on waiting lists. People will not be diagnosed or given access to treatment as quickly as they need, resulting in more serious health outcomes and greater costs for the Exchequer in the long term. As I have said in previous debates, cuts bluntly implemented do not produce savings. We need to recognise that the agenda of austerity is not working and we need to address that fundamental problem. Savaging our health services will certainly not deal with unemployment or protect our economy in the future.
The budget cut €85 million from hospitals, which will have a serious impact. A saving of €12 million comes from a reduction in the pay at entry level for student nurses, which is a crude attack on young women and men coming into public service to dedicate their lives to public health. The moratorium on public sector recruitment means that speech and language therapists and other specialists cannot be recruited. We are losing five public health nurses at the end of this month. The key point is that it is not an economically sensible way to approach this. Despite what the plan states, many of these hours, for example in the nursing sector, will be made up by agency staff. Where is the saving in that?
In my hand I have the draft cost-containment plan for Connolly Hospital in Blanchardstown, which serves approximately 300,000 people. The plan was produced as a consequence of the cuts made by the HSE and the Minister for Health, Deputy Reilly. It refers to bed closures, reviewing access to different units and procedures in the hospital and closing day wards. However, section 60 of the report on the emergency department is blank. Three months ago the Minister gave a commitment that the accident and emergency department would be secure and would remain open 24 hours a day, seven days a week. Why does the plan make no mention of it? The Minister, Deputy Reilly, should give a commitment that the accident and emergency department will remain open 24 hours a day, seven days a week. If it does not remain so, the people of Dublin West and the other communities the hospital serves will not accept it and there will be a massive campaign of resistance. We must protect our accident and emergency departments and not blame public servants who are taking massive cuts. There is an agenda among some parties - some in Fine Gael have said it publicly - to attack the Croke Park agreement. That does not represent the future for our health service or our economy. We must rethink, re-engage and ask those who have most to pay most. That is why I do not agree with the plan that has been put before us today.
I have been a doctor for 20 years and have been in politics for ten years. It is amazing when one switches from the Opposition to the Government side the arguments seldom change.
I always made these arguments.
The solutions are far more important at this time. In the time I have been involved in politics I have seen some progressive changes in the health services and I work with the dedicated public service to which Deputy Nulty referred on a regular basis. Even in the decade I have been in politics, the problems with the use of computers and IT in the health service have not been addressed. We still have a hopeless implementation policy for the use of information technology in the hospital sector. For instance, I cannot get blood test results via broadband, but must continue to get them via an ISDN line because the HSE does not want to use broadband to transfer information from the laboratories to doctors' surgeries. I cannot send an e-mail to hospital consultants but must send faxes or letters. These would be considered ridiculous by most businesses, but that is what is happening.
There are continual problems with the care of the elderly and how we will address it in the future. That was an issue a decade ago and remains an issue. In these more difficult times, it requires us to be very conscious of what we are doing because we need to look after our elderly people who can no longer look after themselves. Access to hospital services is still poor and is inconsistent across the country. People in the south east wait four years to see an orthopaedic surgeon and three years to see an ear, nose and throat surgeon. However, patients in other parts of the country will wait longer for different types of services, for example speech and language services. If we could not sort out these problems when we called ourselves the richest nation in the world, we will certainly have trouble sorting them out now that we are in such difficult financial times.
Access to primary care and mental health services will also be a problem. As Deputy Browne is aware, St. Senan's Hospital, which was a Victorian institution, was closed as we are trying to move services for people with mental health problems into the community. There is a need to destigmatise people with mental health problems and treat them as normal members of the community who should not feel they should be locked up when getting treatment for those problems. All health care is moving away from the acute hospital setting and mental health should do so also.
I know that Fianna Fáil's Private Members' motion tonight concerns small schools. A large number of people in the public sector undoubtedly feel that an attack is being made on them, but that is not the case. There is an agreement with the public sector unions to implement the Croke Park agreement. There is a need to implement that agreement in order to protect services in the future and we must implement it quickly. There is no Croke Park agreement for the service users, students, patients or pensioners. It is very important that all public servants, including doctors, nurses, teachers and politicians, work together to ensure the service users we are looking after get the best possible service. That is the point some members of my party are making about the Croke Park agreement. It is not about getting rid of it and having strife with people who work in the public sector which would be pointless. It is about implementing the Croke Park agreement in order to deliver the best possible service we can in the worst financial times the country has ever experienced. Everybody acknowledges that public sector workers have taken pay cuts of 15% to 25%, which is a significant hit in households dependent on the income that derives from the State.
There is urgent need to make changes and we need to review everything. Hospital theatres lie empty at night and some hospital consultants are not actually working. We are paying those consultants €160,000 a year and they will openly admit they have no work to do because they have no access to theatres. In recent years we made major changes to how hospitals are administered and run. We may need to review some of those changes to see if they remain fit for purpose. Many of those changes were made because we were pouring money into the health services without any necessary regard to how that money was being spent. Undoubtedly a significant portion of that money was poorly spent. We structured our health services in a way that may not work well in these more difficult times. We meet people all the time who know we can make our health, educational and other public services work better. That spirit of co-operation will remain, but we need to get down to working on this issue, which is far too important for the people involved.
I see great potential in what the Minister for Health, Deputy Reilly, proposes. He talks about the money following the patient. Many of those who contributed to this debate spoke about specific concerns in their areas. Deputy O'Donnell spoke about the Mid-Western Regional Hospital. I visited that area six years ago when there were plans to close the hospitals in Nenagh and Ennis. At the time it was quite obvious that the Mid-Western Regional Hospital would have problems dealing with this extra workload. The Deputy is correct in pointing out that hospital has below the national average number of doctors, nurses and allied health-care professionals considering the throughput in the hospital, and it was clearly going to run into problems. This happens in a number of hospitals. Many people might not understand that hospitals such as the Mid-Western Regional Hospital and Waterford Regional Hospital have similar workloads to St. Vincent's University Hospital, which has 1,200 more staff than either of those regional hospitals.
The staff complement in Waterford Regional Hospital is 2,700, representing a significant difference for these hospitals. One cannot simply compare these hospitals in an absolute sense because St. Vincent's University Hospital carries out a good deal of specialised work not carried out in the other two hospitals. However, by and large, much of the work done in all three hospitals is similar. These are the issues the Minister, Deputy James Reilly, is considering now. He is trying to find efficiencies in the health service at present.
There is a need to make other changes for the future. There is a need to ensure that we focus on health promotion, health prevention and health screening. We must try to catch disease before it gets to people. Previously we used to discuss high blood pressure and diabetes. However, these diseases are now being overtaken by a condition called metabolic disease. This is made up of diabetes, high blood pressure, obesity and high cholesterol. Vast numbers of the population are affected by all of these illnesses at the same time. Vast health resources will be required in future to look after patients and we must plan for the explosion that will occur in this country in the coming decade or 15 years. Otherwise, there will be an even greater crisis in our heath service than that which we perceive at the moment. There are problems now and there will be problems in future. Unfortunately, because of the financial crisis we are making significant cuts and these will hit front line services. There will be reductions but I believe that we have a great opportunity to change things. It will not be perfect.
Deputy Browne will remember his former party colleague, Charlie McCreevy, who stated that he would not put any more money into health because putting money into health was like pouring money down a black hole. That is not correct but the point he was making was that health services will consume as much money as one wishes to put into it. In these limited times we must try to get the best possible outcomes for the money we are putting into the health services and we continue to put a significant amount of money into health.
I wish to make some remarks about private health insurance. The genesis of the problems with private health insurance today dates back to meetings of the Joint Committee on Health and Children in 2005 and the position of the then Minister, Mary Harney, on risk equalisation and the way in which the structure of community rating was set up in the country. The then Minister, Mary Harney, chose to believe there was no problem. No more than she ever expected that we would be in the position we are in today, the genesis of many of the problems we face in private health insurance now date back to that time when we did not deal properly with the private health industry and the provision of these services to people.
Many people believe that there is no accountability when a patient goes to hospital with VHI cover. The bill is simply sent to the VHI. We do not know what people are being charged for or how much they are being charged. I understand the receipt one receives from the VHI is considered unacceptable to the auditors in the European Union because it does not provide the clarity required.
I welcome the opportunity to discuss the health service plan 2012. The plan, if one could call it that, proposes to reduce the overall health spend by €750 million. This leaves €14 billion to be spent on the health services during 2012. One would expect €14 billion to be sufficient to provide an adequate health service for the people. However, as is the case with any plan from the HSE, the cuts begin with the most vulnerable and the least well-off in our society. The consultants, doctors and senior management at the top are usually left to one side and they are not obliged to take the necessary reductions to bring about savings. Deputy Twomey referred to efficiencies. Surely efficiencies should start with the leaders in the HSE. There are enough managers throughout the country to devise a practical plan.
The Minister has okayed the plan before us this week. At first he sent it back to the HSE but he approved the plan eventually. This was a window-dressing exercise by the Minister to allow him to wash his hands of the plan. We are all aware that the Department of Health and the HSE have worked hand-in-hand to draw up a plan for the health service in the future.
Let us consider the implications of the plan in my area in the south east. Leaks have come from Waterford Regional Hospital in recent weeks. We will see the closure of three of its eight operating theatres. Elective procedures are set to be hit first. Waiting lists for specialist surgery will lengthen and there will be some restrictions in respect of specialist drugs as well. Let us consider the case of Wexford General Hospital. It is difficult to get information about Wexford General Hospital. However, I have done some investigative work in the past week involving staff within the hospital. They have informed me that approximately 55 staff will be lost to the hospital because of redundancies, retirements and people leaving the service. The medical admissions unit will close at weekends, from Friday evening to Monday morning, orderly security will be cut and some wards will be closed at night time. This will have a devastating effect on the hospital.
The two major hospitals in the south east will suffer from the severe reductions in the services available to the general public. Before he concludes the debate, the Minister should explain fully the reductions that will come about because of the HSE plan on a hospital-by-hospital basis. I understand there will be a reduction of €1 million in the ambulance service budget in the HSE south region. This will seriously affect the ambulance service in the south east region, which both Deputy Twomey and myself represent.
I refer to the ongoing medical card debacle. I have before me a file containing 140 medical card queries from the people of my county, some of which date back to last August when those involved first applied for a medical card. These people have not yet received a medical card. There are delaying tactics although I do not suggest the Minister is deliberately delaying the issuing of medical cards. The centralising of the issuing of medical cards took place on our watch. Many backbench Fianna Fáil people objected at the time to the centralisation of the medical card system because when it was operated on a county-by-county basis, people were able to get a medical card reasonably quickly and if there was a problem they were able to go to the local medical card office and sort out the problem. Now one must telephone the medical card office in Dublin. The staff there are not to blame - they are doing their best - but there is a difficulty because of the vast number of medical card applications which they must process in one office in Dublin. It is scandalous that people have been waiting since last August or September for their medical cards.
I realise Deputy Twomey and other doctors have been trying to provide this service in the hope that people will eventually get their medical cards but doctors are getting fed up of this as well. In addition, chemists are becoming fed up of supplying the drugs in the hope that people might get a medical card at some stage in future. It is not good enough for the Minister to have stated in the House last week that there is a 15-day turnaround for the issuing of medical cards. This is not the case. Certainly, it is not the case in my county and I doubt whether it is the case in any other county. There may be a scarcity of staff but it is important that staff are put into the medical card offices in Dublin to clear the backlog and to ensure that people who deserve medical cards get them quickly and on time.
There are cases of people suffering from cancer and other serious illnesses and they are being denied the medical card which would allow them to get the drugs they require. We know of cases where people are not going to the doctor although they are seriously ill because they do not have the medical card to cover the cost of the visit or the cost of the drugs required to treat the illness. Doctors and chemists in my county have done their best up to now but they are becoming increasingly annoyed with the ongoing delays. In some cases, they believe it is a cynical exercise to slow down the issuing of medical cards and to reduce the costs associated with them. I call on Deputy Twomey to ensure that the Minister, Deputy Reilly, increases the number of staff making decisions on and working on the issuing of medical cards.